OSCE Pediatric Assessment 4 — Questions and Answers
Question 1: A 2-year-old presents with a barking cough, stridor at rest, and moderate sternal recession. Using the Westley Croup Score, this child most likely has:
- Mild croup — discharge with advice
- Moderate croup — nebulized epinephrine and dexamethasone (Correct answer)
- Severe croup — immediate intubation
- Spasmodic croup — antihistamine therapy
Correct answer: Moderate croup — nebulized epinephrine and dexamethasone
Stridor at rest with sternal recession indicates moderate croup, managed with nebulized epinephrine and systemic dexamethasone.
Question 2: During a neonatal examination, a midwife asks you about the significance of a persistently open posterior fontanelle at 3 months of age. What is the most important association?
- Normal variant requiring no action
- Hypothyroidism (Correct answer)
- Hydrocephalus
- Rickets
Correct answer: Hypothyroidism
A large or persistently open posterior fontanelle beyond the first weeks of life is associated with congenital hypothyroidism and warrants thyroid function testing.
Question 3: A 6-year-old presents with a first unprovoked seizure lasting 3 minutes that has now resolved. He is post-ictal but vital signs are stable. What is the first-line management?
- Give IV lorazepam immediately
- Perform a full history and examination; investigate appropriately (Correct answer)
- Start long-term antiepileptic therapy now
- Order emergency CT brain
Correct answer: Perform a full history and examination; investigate appropriately
After a first brief afebrile seizure that has self-terminated, clinical assessment and targeted investigation guide management before committing to antiepileptics.
Question 4: On auscultating a 5-year-old's chest, you hear a soft, blowing, systolic murmur at the left sternal edge that disappears when the child stands. What is this most likely?
- Ventricular septal defect
- Innocent (flow) murmur (Correct answer)
- Mitral valve prolapse
- Pulmonary stenosis
Correct answer: Innocent (flow) murmur
An innocent murmur is typically soft, systolic, localised to the left sternal border, and classically diminishes or disappears on standing.
Question 5: A 4-week-old presents with jaundice. Bilirubin is predominantly conjugated (direct). What is the most important diagnosis to exclude urgently?
- Physiological jaundice
- Breast milk jaundice
- Biliary atresia (Correct answer)
- Neonatal hepatitis from CMV
Correct answer: Biliary atresia
Conjugated hyperbilirubinemia in a neonate is never physiological and biliary atresia must be excluded urgently as Kasai portoenterostomy is time-sensitive.
Question 6: You are asked to assess a 9-year-old's blood pressure. The cuff bladder should cover what proportion of the upper arm circumference?
- 25–30%
- 40–50%
- 80–100% (Correct answer)
- Over 100%
Correct answer: 80–100%
The cuff bladder should encircle 80–100% of the upper arm circumference to avoid falsely high or low readings.
Question 7: A 14-year-old girl presents with primary amenorrhea. On examination she is short, has a webbed neck, and widely spaced nipples. What is the most likely diagnosis?
- Polycystic ovary syndrome
- Constitutional delay of puberty
- Turner syndrome (45,X) (Correct answer)
- Anorexia nervosa
Correct answer: Turner syndrome (45,X)
Turner syndrome (45,X) presents with short stature, webbed neck, widely spaced nipples, and primary amenorrhoea due to gonadal dysgenesis.
OSCE Pediatric Assessment 4
A 2-year-old presents with a barking cough, stridor at rest, and moderate sternal recession.
Using the Westley Croup Score, this child most likely has: